摘要:

Seven patients with acquired immunodeficiency syndrome (AIDS) andPneumocystis cariniipneumonia were studied to define the pathophysiology of their respiratory failure. The patients had fever, cough, dyspnea, hypoxemia, and diffuse infiltrates on chest x-ray. Biopsies revealed a spectrum of alveolar filling, interstitial edema and infiltration, and fibrosis. The patients were studied on mechanical ventilation to assess the effect of positive end-expiratory pressure (PEEP) and supplemental oxygen on shunt fraction. Mean anatomic shunt (measured on 100% oxygen) was 34 ± 8%, which increased significantly (p< .001) to 43 ± 9% when the FIO2was decreased to 40% to 60% (physiologic shunt), indicating ventilation/perfusion (V/Q) imbalance or impaired diffusion. Increasing PEEP by 9 ± 2 cm H2O reduced the anatomic shunt to 30 ± 7% (p< .01) and the physiologic shunt to 37 ± 7% (p< .02). There was a similar decrease in anatomic and physiologic shunts in five studies, a greater decrease in physiologic shunt in four, and a greater decrease in anatomic shunt in two. Evidence of alveolar recruitment with PEEP, measured by an increase in static thoracic compliance, was found in only one study. There was no correlation between the effect of PEEP on compliance and its effect on shunt. The data suggest that in patients with AIDS andP. cariniipneumonia, PEEP can decrease shunt by reducing the anatomic shunt, improving V/Q imbalance, and converting areas of anatomic shunt to areas of low V/Q.P. cariniipneumonia in patients with AIDS can produce a clinical and pathophysiologic pattern similar to that described in the adult respiratory distress syndrome.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

This study assessed the reliability of131I albumin-dilution for measuring induced changes in plasma volume (PV) immediately after coronary bypass surgery. After injection of the tracer, blood samples were collected from 18 control patients to obtain131I albumin decay curves in the plasma. These curves were used to construct a mathematical model describing tracer decay. PV was then calculated in control patients, and in 51 study patients who received plasma expanders on the first postoperative morning. At 1, 15, 30, and 60 min after volume loading in the study group, dilution volumes were calculated as the difference between predicted and observed plasma radioactivity levels. These calculations were compared to an independent measurement of PV. This method was associated with a measurement error no greater than ± 12% in 82% of the 51 study patients. It tended to underestimate PV by 2.4%.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

During a 3-yr period, 31 adult victims of severe traumatic shock were enrolled in a prospective randomized investigation of the relative effectiveness of dextran 70 vs. Ringer's acetate to treat shock and protect against trauma-induced adult respiratory distress syndrome (ARDS). Fourteen patients were given dextran 70 and Ringer's acetate to compensate for interstitial fluid loss, and whole blood as required; the remaining 17 patients received three to four times the total fluid volume of Ringer's acetate given in the former group, and whole blood as required.Hemodynamics improved significantly more rapidly in the dextran group. In the 7 to 8-day post-trauma period, no patient in the dextran group developed ARDS, compared to five cases of ARDS in the Ringer's acetate group. Also, the cardiac index of dextran patients was significantly higher, and patients challenged with 0.5 L of dextran 70 showed a significantly higher increase in cardiac index than those challenged with 2 L of Ringer's acetate. It is concluded that in the severely traumatized patient, a fluid program based on dextran 70 is superior to Ringer's acetate alone. Furthermore, patients should continue on a fluid program containing dextran 70 to counteract unrecognized, hypovolemia. Our results support the assumption that early aggressive shock treatment with dextran 70, followed by continued dextran administration in the post-trauma period might prevent complications such as ARDS.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

The role of interleukin 1 (IL 1) in 16 patients with sepsis and 16 normal controls was investigated. Thymocyte costimulation was used to assay in vitro IL 1 levels produced by adherent cells in the peripheral blood, and in vivo IL 1 levels in the serum. Adherent cells (i.e., monocytes) from nonsurviving septic patients produced significantly less IL 1 activity than cells from healthy controls or surviving patients, either spontaneously or by silica stimulation. In contrast, in vitro IL 2 production by T lymphocytes was not altered in septic patients. Serum IL 1 activity was determined using serum fractions from high-pressure liquid chromatographic gel filtration. Suppressor factors in healthy subjects as well as septic patients usually eluted at molecular weights above 50 kilodaltons, while IL 1-like activity was normally present between 35 and 1 kilodaltons. Sera of nonsurviving septic patients contained significantly less IL 1 compared to that of controls or surviving patients. Thus, decreased serum IL 1 levels and diminished monocyte production of IL 1 appear to be negative prognostic indicators, possibly reflecting a breakdown of mononuclear phagocytes.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Prostaglandin (PG) levels and M-mode echocardiography were used to evaluate the severity of patent ductus arteriosus (PDA) in 19 premature infants. Mean 6-keto-PGF1αlevels in infants with more severe left-to-right shunting were significantly higher than those in infants with a moderate level of shunting (1335 ± 763 vs. 504 ± 348 pg/ml, respectively). Furthermore, there was a significant correlation between this elevation and a decrease in the left ventricular systolic time interval, suggesting that both reflect the severity of ductal shunting. Although other echocardiographic measurements of cardiovascular function generally showed some tendency to vary with 6-keto-PGF1αlevels, none was as closely correlated with the extent of PG elevation. Levels of PGE2also seemed to vary with PDA severity; however, this correlation was not as significant.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Mortality and neurologic morbidity were evaluated in children who were successfully resuscitated after being brought to an emergency room with continued apnea and pulselessness. Of 34 patients studied from June 1981 through August 1984, 27 died during the initial hospitalization and seven (21%) survived until hospital discharge. Of the seven surviving children who were discharged to a chronic care facility, five remain in a vegetative state. Possible explanations for this high mortality and neurologic morbidity are discussed.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

We retrospectively reviewed the results of 42 cardiopulmonary arrests occurring over 1 yr in the general ward of a pediatric hospital. These data were compared to those of a similar study done 10 yr previously in the same institution. Patients were divided into those having pure respiratory arrest and those who also had cardiac arrest. In the most recent series, overall 6-month survival was 17%; however, only 9% of the cardiac arrest patients survived. Ten years previously, the survival rate from cardiac arrest was 11%. In both series, pure respiratory arrest had a significantly better outcome than cardiopulmonary arrest, and predictors of nonsurvival were a duration of arrest greater than 15 min and the administration of more than one iv bolus of epinephrine. During the more recent series, sepsis and apper airway problems produced fewer arrests. There was one neurologically damaged survivor in each study period. Our study confirms that the outcome of pediatric cardiac arrest is poor when arrest occurs in the hospital.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Recently, we encountered four neonates who developed severe reversible partial lower airway obstruction. This communication describes their clinical course and the pathogenesis and treatment of acute bronchospasm resembling status asthmaticus and leading to life-threatening respiratory acidosis.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Intralipid elimination patterns were compared in 25 healthy controls, 12 patients recovering from uncomplicated cholecystectomy, and 25 critically ill patients. The intravenous fat tolerance test revealed a similar fractional removal rate (k2) in healthy controls and critically ill patients, but k2was increased in cholecystectomy patients. The concentration of cross-reactive protein (CRP) correlated positively to the concentration of total triglyceride and low-density lipoprotein-triglyceride, and negatively to low-density lipoprotein-cholesterol and high-density lipoprotein-cholesterol. The extrapolated zero-time concentration of Intralipid in the critically ill patients was only one-third of the value in healthy controls. After this initial loss, however, Intralipid was removed from the circulation after first-order kinetics. These low concentrations of Intralipid were not correlated with concentrations of CRP. Possible explanations for this phenomenon include a change in the configuration of the lipid particles, the so-called creaming phenomenon, and/or immediate and substantial uptake of the emulsion by certain organs.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

The efficacy of gabexate mesilate (FOY), a synthetic serine proteinase inhibitor, was compared with that of heparin in preventing the acceleration of bleeding after hemodialysis. Transfused blood volume (TBV) was measured 24 h before and after 24 dialyses in 14 bleeding patients with impaired hemostatic function. The predialysis TBV did not differ significantly between heparin and FOY groups; however, TBV was significantly (p< .05) larger after heparin dialysis than after FOY dialysis. After dialysis, TBV was increased in eight of nine heparin patients, compared to only three of 15 FOY subjects (p< .01). FOY is an effective agent and may decrease postdialysis bleeding complications in certain high-risk patients.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID